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Proctoscopy

Introduction
Proctoscopy is an internal examination of the anus and the lower part of the rectum. The examination is performed using a proctoscope (a plastic or metal tube with a lamp in it), by or under the supervision of a specialised surgeon. You will be supported by a nurse. The examination will take place on the Endoscopy department (3rd floor, route 36).

The goal of the examination is to determine abnormalities of the anus or the lower part of the rectum such as haemorrhoids, a tear of the skin (fissure), inflammation or stricture. It is also possible to perform minor procedures during the proctoscopy, such as taking tissue samples for laboratory testing or the treatment of haemorrhoids.

Preparation
For this examination, no special preparation is needed. You may eat and drink as you please. The examination can also take place during menstruation.

If you are using bloodthinning medication such as Acenocoumarol, (Sintrommitis), Fenprocoumon (Marcoumar), Ascal, Plavix, or Persantin, please ask the doctor who requested the proctoscopy for you if you should temporarily stop taking the bloodthinners and also report this to the thrombosis care department. The performance of minor procedures in particular can lead to blood loss if you do not temporarily stop taking bloodthinners.

We advise you not to come to the hospital on a bicycle and to bring someone else with you.

The examination

  • Immediately prior to the examination, the doctor will discuss with you the reason for the examination and enquire about your medical history and use of medication.
  • After that, you must take off your trousers/skirt or dress, your underpants and shoes.
  • You lay down on the examination table on your left side, with your knees bent.
  • The nurse will partially cover your lower body with a sheet.
  • The doctor will first perform an external examination of the anus and the surrounding area.
  • Subsequently, the doctor will perform an internal examination of the anus with a finger.
  • After that, the proctoscope will be gently inserted into the anus and the mucous membrane inspected.
  • Subsequently, the proctoscope will be pulled out slowly.
  • Should a minor procedure be necessary, such as the treatment of haemorrhoids, the doctor will discuss this with you and,  in principle, this will be done immediately.
How long does this examination take?
The examination itself will take about five minutes. When a minor procedure is performed directly afterwards, the examination may take a little longer. After the examination, the doctor will discuss with you the further course of treatment. You will be in the examination room for approximately 15 minutes.

Does the examination hurt?
The insertion of the proctoscope is an unpleasant experience for most people. Yet, if you are able to relax it should not hurt, unless there are painful abnormalities such as a tear in the anus. In that case, a sedative ointment will be applied around the anus.

Normally minor procedures such as taking tissue samples for further examination are not painful. If necessary, the doctor may decide to administer local anaesthesia by injection.

The treatment of haemorrhoids
Haemorrhoids (prolapsed and swollen rectal veins) can be treated during the proctoscopy. The doctor will place a few rubber bands onto the haemorrhoids through the proctoscope. This is called rubber band ligation. Most patients do not feel pain when the rubber bands are placed. Therefore, sedation is not necessary. Approximately 10 % of patients feel pain after the rubber bands have been placed (an unpleasant sensation in the lower abdomen). Generally, this will wear off within 24 hours. If necessary, you can take Paracetamol. You will probably have a (false) urge to defecate but this feeling will wear off during the day. Five to seven days after the treatment, the rubber bands will, in principle, disappear along with the defecation. There can be accompanying temporary (additional) blood loss. You do not need to worry about this. If necessary, the doctor will give you some dietary advice and/or a prescription to ensure regular bowel movements. In most cases, the complaints are remedied after one treatment. However, a second or third treatment is sometimes necessary.

The results
The doctor will discuss his findings with you directly after the treatment. If necessary, an appointment for a check-up proctoscopy will be made or you will get an appointment for a consultation by telephone with the doctor.

Complications
Proctoscopy is a safe examination method. Complications are very rare. The chances of a complication are slightly greater when a minor procedure is performed during the proctoscopy. Should you have the following complaints after the examination:
  • heavy blood loss (more than a cup full)
  • difficulty urinating, not being able to urinate
  • continuous and heavy pains

please immediately contact the Accident & Emergency Department (Spoedeisende Hulp) of our hospital through telephone number: 070 - 312 44 45.

Conclusion
If, after reading this leaflet, you still have questions, you may contact the Endoscopy Department. The department can be reached on workdays from 08.00 - 13.00 hrs. through telephone number 070 - 312 46 88.

We appreciate your opinion. If you have any comments or suggestions concerning this brochure or your treatment, please let us know.

Edition: March 2010/70